Over at the New York Times, it looks like the left hand doesn't know what the right hand is doing. Readers today may have noticed a distinct schizophrenia between the Times coverage of New York State Hospital closures on the front page and on its editorial pages. Unfortunately, despite two tries, the Times still fails to get the story right.
The front page notes that while the Berger Commission proposed closing 9 hospitals, other recommendations on "right sizing" 48 other institutions constituted sweeping change that could have profound effects on NY State health care:
The nine hospital closings, with five of them in New York City, have received the most attention, but other elements in the plan could have
greater effects. Stephen Berger, the commission chairman, said at a news conference that far more significant were the commission’s proposals to reshape dozens of other hospitals through mergers, downsizing, the elimination of some services and the addition of others.“The reason this is a big deal is the 48 reconfigurations,” he said.
Industry
officials agreed with that assessment, and said they were taken aback by the number and detail of changes that some described as micromanaging.
Over on the Op-Ed page, however, the Gray Lady's editorial board praised the Commission for its "modest" and "courageous" actions in reigning in New York's wayward hospital system. For the editors, the only real problem lies with the legislature - "cowards" who might choose to reject the courageous commission's recommendations.
Both articles fail to note that the closings and restructuring will likely exacerbate existing health disparities - particularly in major metropolitan areas - and take jobs away from many health care workers. Both articles also fail to note that the chance of the legislature rejecting the Commision's recommendations are next to zero due to a promised federal bail-out of the system (to the tune of $1.5 Billion) contingent upon the state's acceptance (pdf) and implementation of the commission's recommendations.
Our partners at New York Lawyers for the Public Interest covered this much more thoroughly and eloquently than I could. Here is a letter they sent to Governor Pataki and Governor Elect Spitzer about yesterday's announcement:
Governor Elect Eliot Spitzer
Governor George Pataki
State Capitol
Albany, NY 12224Re: The Commission on Health Care Facilities in the 21st Century’s Failure to Address Racial Disparities in Access to Health Care
Governor Pataki and Governor Elect Spitzer:
We write today because we are deeply concerned that the recommendations of the New York State Commission on Health Care Facilities in the 21st Century (the Berger Commission) did not fully address the disparate impact down-sizing of health care will have on already medically underserved communities
of color and poverty in New York City. Scant resources stand to be further depleted for communities that simply cannot withstand, and should not be required to withstand, any further reduction – particularly without any plan for building health care infrastructure to address the critical health needs in these neighborhoods.We appreciate the hard work that the Berger Commission has undertaken to tackle serious financial strains in our health care system. However, priority should have been given to addressing racial disparities in access to health care, disparities which have been known for decades, and which are intolerable in a modern society with resources such as ours.
The tragic disparities in incidence of disease, morbidity, and mortality have been known for many decades. During a period of economic trouble in the late 1970s, experts such as Alan Sager testified before Congress about the dangers of closing urban hospitals that were needed in medically underserved communities. In the early 1980s, communities fought the threatened closure of Sydenham and Metropolitan Hospitals serving Harlem.
In 1993, the now defunct Health Systems Agency (HSA) of New York City issued a final report, “A Framework for Primary Care Needs Analysis in New York City,” which documented gross disparities in access to care and severe health care shortages in communities of color. On a national level, in 2003, the Institute of Medicine of the National Academy of Sciences issued a report, “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care,” which crystallized the need to address and remedy disparities in access to care. And, in 2005, Bronx Health Reach published a report, “Separate and Unequal: Medical Apartheid in New York City,” documenting extreme disparities in access to health care institutions in New York City.
Why,after so many decades of awareness of the terrible problems with racial disparities in health status and access to care, does the state of New York propose a plan that fails to challenge, much less begin to fix, the dire state of our status quo when it comes to racial disparities in health status and access to health care?
Communities such as Central Brooklyn are medically underserved areas by any definition of the term, including the United States Department of Health and Human Services’ definition. Nonetheless, Central Brooklynhas recently suffered losses of critical hospital services. Why, after years of hospital losses and down-sizing in areas like Central Brooklyn, did the state of New York create a Commission that sets in motion further down-sizing without a concomitant mandate to tackle the problem of the underserved?
The debate to ensue around the Commission’s recommendations and the transition in leadership in 2007 presents us with a critical opportunity to focus, and to redirect resources to address critical health care needs in underserved communities in New York City and across the state. We ask that you work together during this period of transition to ensure that the Berger Commission’s down-sizing is not the legacy of this moment. We ask for a moratorium on closures and down-sizing in medically underserved areas until real plans are made for new institutions to fill in the gaps; until plans are created for conducting needs assessments; until plans for primary, ambulatory, and specialized care for underserved populations are developed. We ask that you follow the principle first do no harm.
The Crisis in Central Brooklyn
A number of communities of color in New York City do not have sufficient access to health care facilities or health professionals, resulting in well documented and extreme health disparities. Despite these shortages, the State has made the untenable decision to close financially struggling hospitals, but yet has
made no express commitment to preserve—let alone improve—health services in medically underserved areas, and the health of the poorest New Yorkers will only deteriorate and become a further burden on the safety-net hospitals that escape closure.Without comprehensive community and health planning, closing hospitals is a short-sighted attempt at saving dollars, as it will immediately overburden nearby hospitals, and over time allow some of the sickest and the poorest to become much sicker. Building access to primary, ambulatory and specialty care to treat and control chronic illnesses would have long term financial benefits for the state, but thus far the state has unfortunately not chosen to cast its sights in that direction. Any workable solution to New York’s health care crisis, including the State’s Medicaid budget, must include community health planning and a needs assessment to ensure sufficient access to health care. Yet, the Berger Commission has taken none of these necessary steps before making recommendations that will irreparably change the State’s health care system.
A prime example of the inequities in New York’s health care system can be found in Central Brooklyn, a medically underserved community that is approximately 90% African-American and Latino, and in some areas suffers an infant mortality rate approximately three times the rate in wealthier parts of Manhattan. The health risks to infants born in Central Brooklyn should come as no surprise given the shortage of hospitals and other providers in that area. Despite a surge in population over the last forty years, Central Brooklyn has experienced a 40% reduction in hospital beds during that time period, and recently lost desperately needed maternity beds at St. Mary’s Hospital (now closed) and Interfaith Medical Center Central Brooklyn, with a population of more than 350,000 women, now has only 104 certified obstetric beds. By comparison, the Upper East Side, with an 82% white population, and a population of only approximately 111,060 women, has at least 234 certified obstetric beds. The inequitable distribution of hospital resources has dire consequences: the Brownsville section of Central Brooklyn has an infant mortality rate of 12.2 infant deaths per thousand, while across the river in the Upper East Side, the infant mortality rate is a mere 3.7. These disparities should not be tolerated.
By approving the hospital closures and down-sizing in recent years in Central Brooklyn, which is already medically underserved, the State not only deprived African-American and Latino mothers of critical health care, but also treaded on federal regulations promulgated under Title VI, which prohibits actions with racially disparate impacts. Given this landscape, the Berger Commission’s failure to propose community planning to redirect resources toward addressing critical health care needs in underserved communities is a missed opportunity.
The Berger Commission
Had the Berger Commission examined racial disparities and more fully taken community needs into account, the resulting recommendations could have included recommendations for the development of infrastructure in medically underserved communities. But instead, the Commission’s process lacked
transparency, public participation, and consideration of the most pressing problems in medically underserved communities – lack of access to care.It is unconscionable to change the State’s health care system fundamentally without a transparent process, public participation, and political accountability. Yet, the Berger Commission’s structure has resulted in a patently undemocratic process that disadvantages the residents of New York City. For example, despite having 42% of the State’s population, New York City was considered only one of six statewide health care regions. New York City is underrepresented in the Commission’s body, which is equally represented by six regions, which may account for why five of the nine hospitals slated for closure are in New York City.
An unelected body is effectively rewriting established public health law. Even the limited oversight that the Senate and Assembly retains over the Commission is illusory, as the legislature will not convene in regular session during the 26 days they have to debate and pass a resolution rejecting the recommendations. It is telling that the state has devised a relatively quiet and unaccountable method for making these politically difficult choices about hospitals. Would that such imagination was applied to solving the problems of racial disparities in access to health care in this city and state.
A Call to Action
In reaction to the Berger Commission, the New York City Health and Hospitals Corporation has found that, “hospital closures could eliminate a major source of primary care and exacerbate existing shortages, particularly those experienced by low-income New Yorkers. This would worsen community health status, heighten disparities, and increase costly but avoidable emergency room and inpatient
utilization.” The Boston School of Public Health has issued a report, “Closing Hospitals Won’t Save Money But Will Harm Access to Health Care,” warning of the short-sightedness of the Berger Commission.
The Save Our Safety Net Coalition, a group of community advocates and labor has advocated for repeal and re-tooling of the Berger Commission’s enabling legislation. The Primary Care Development
Corporation has issued a report calling for much needed investment in primary care for underserved areas. The message is clear: first do no harm.The Department of Health and the office of the Governor have the ability to envision creative solutions, and the power to execute them. We ask that you take this critical opportunity to focus, and to redirect resources toward addressing critical health care needs in underserved communities in New York and across the state. We ask for a moratorium on closures and down-sizing of hospitals in medically underserved
areas until plans are made for new institutions to fill in the gaps, for conducting needs assessments, and plans for the development of primary, ambulatory, and specialized care for underserved populations. We ask that you do no more harm. After 40 years of neglect, medically underserved communities deserve your leadership now.We would welcome the opportunity to meet with you to discuss plans for building health care infrastructure in medically underserved areas, and addressing the racial and ethnic disparities in health care in New York in the coming days.
For more information - including fact sheets, maps (of New York City), and reports, visit The Opportunity Agenda.
If you would like to take action, you can send you comments to the state assembly here:
HealthHearing@assembly.state.ny.us
Or write to the New York Times about its coverage.
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